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General NPI Number Information
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NPI Number | 1982196564
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Entity Type | Individual
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Provider Name | VERA IRINA PRISACARI MD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 3425 COFFEE RD STE A2
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City | MODESTO
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State | CA
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Zip | 95355-1582
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Country | US
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Telephone | 209-521-6452
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Fax |
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Provider Business Mailing Address
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Address Line | 3425 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-1582
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Country | US
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Telephone | 209-521-6452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2018017163
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License Number State | MO
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